Across fields, care professionals have been moving away from an institutional, task-oriented approach and toward a more holistic approach. In particular, this effort to honor the individual in care—and the person providing care—provides much-needed help for caregivers of dementia patients.
It is a philosophy of service provision where services are maximally responsive to unique needs, values, and preferences of the individual.
A study in the American Journal of Alzheimer’s Disease and Other Dementias reached findings that we at CPI see every day from customers, across a wide range of fields, who use a client-centered, strength-based approach.
The study measured how people living with dementia reacted to being cared for using person-centered communication. It found that person-centered communication resulted in people with dementia:
- Cooperating with staff
- Revealing personal information about themselves (showing trust and security)
- Contributing to conversations
- Asking for clarification
- Increasing politeness toward staff
The study also revealed that with client-centered communication, staff were more likely to regard their clients in a positive light.
Person-centered care creates a positive feedback loop between staff and clients.
Person-focused communication begets positive client behavior and responses, which begets a positive view of clients for staff, which further elicits positive client behavior and responses.
In CPI training, this is what we call the Integrated Experience.
The Integrated Experience provides help for caregivers of dementia patients by introducing the concept that staff behaviors and attitudes impact the behaviors and attitudes of those in their care, and vice versa.
In any field, as in any part of life, how someone treats you has a direct effect on how you treat them.
The evolution of person-centeredness
Tom Kitwood, a psychology lecturer at the University of Bradford, is considered the originator of the person-centered approach in dementia care. His groundbreaking 1997 work, Dementia Reconsidered: The Person Comes First, explored the concept of personhood. It remains the authority on the topic, guiding policy makers, service planners, and thought leaders on best practices in dementia care.
Kitwood's work is central to best practices for many fields, and it informs both our Dementia Capable Care and Nonviolent Crisis Intervention® training.
In 2001, person-centered planning became part of government policy in the UK as part of the Putting People First initiative in social care. The Department of Health’s white paper on Valuing People [PDF] outlines a strategy for using person-centered care with people who have learning disabilities.
These days, as Hazel Watson of NHS England tweeted, “person-centered care at its best” applies to people of all ages and all abilities—especially when they’re vulnerable.
The shift toward person-centeredness continues in many environments, from long-term care facilities to schools, EDs, and psych units. Particularly in behavioral health care, the focus is shifting to a recovery-model framework that’s trauma-sensitive and trauma-informed.
In dementia care, the Centers for Medicare & Medicaid Services added rules for long-term care facilities that include a section on Comprehensive Person-Centered Care Planning.
Person-centered care is also making its way into hospital security, as security staff move away from an authoritative approach and coordinate with clinical staff to balance care and welfare with safety and security.
With person-centered care, a holistic view of the person in care evolves into:
- Checking assumptions
- Choosing language and vocabulary carefully
- Leveling the hierarchy within the organization
- Changing expectations and beliefs about people
- Adjusting attitudes
- Building support networks to wrap around those in care
Read what CPI Certified Instructors had to say about teaching and apply person-centered care.
These 12 strategies provide help for caregivers of dementia patients by making their approach more person-centered
1. Help the person manage their own care
When someone needs your help, make sure they have input. Listen to their preferences. Empower them to be and feel involved with your care team. Make them full partners in their own care. Put the person in the center, with all other players (family, clinicians, caregivers, teachers, administrators, therapists, etc.) comprising a customized circle of support.
Show the person that their individual needs, interests, passions, likes, and dreams are always the core focus of every effort. Let them know that to the best of your ability, you will minimize what they don’t like and maximize what they do like.
2. Ask the person about their preferences
Offer choices and let the person know you aim to meet their needs. For example, if they don’t like to shower in the morning, can you allow them to choose the time of day that feels best for them? If you can offer personalized options and flexibility, you can often avoid unnecessary altercations.
CPI’s Life Story Questionnaire is a great tool if you work with people who have dementia. And no matter where you work, our Trauma-Informed Care Resources Guide includes a De-Escalation Preferences Form that can be a huge help to both you and the person in your care.
3. Get to know the person
- What’s their background?
- What are their interests?
- What are they good at?
- What makes them feel supported?
- What makes them feel happy?
- What makes them feel scared?
To find this out, talk to the person. Greet them by name in a friendly tone. Use supportive body language. Be calm and rational and treat them like they’re calm and rational—even if they’re being anything but. Build their trust. Also talk to others; consult with your colleagues, other professionals, the person’s family, etc.
4. Look for the causes of behaviors
Behavior is a form of communication. If a person in your care exhibits difficult behavior, seek to understand the function of the behavior. What you might view as a frustrating behavior may be a coping mechanism attempt. If your response is understanding and individualized, you can help the person replace problem behavior with positive, productive behavior.
5. Do tasks WITH the person
Minimize doing things FOR them. Maximize their abilities. Focus on success, de-emphasize errors, and provide support where needed. To do that, be strengths-based.
Being abilities-focused and strength-based works together with person centeredness. Instead of focusing on deficits and disabilities, look for the person’s potential and recognize what they CAN do with your belief in them and your support of their abilities. Help them feel purpose, skill, accomplishment, and self-respect; this will improve how they feel and act toward you.
6. Offer comfort
With your person-centered responses, you can make something better and be part of the solution. Ways to offer comfort and reassurance include giving the person a pat on the back, a hand on the shoulder, a wink, a thumbs-up, or just being present with the person in a difficult moment.
7. Celebrate
Honor things the person likes. Sing along with them to their favorite song. And let them know when they’re doing a good job. As they achieve benchmarks—even small steps toward their ultimate goals—celebrate.
People are more likely to stick with something when they feel that they’re supported and rewarded for their hard work. Be prepared for small steps backward or unanticipated barriers, but work through them and keep moving forward.
8. Avoid physical intervention
If the person you’re working with sometimes poses a physical danger to self or others, there may be times when you need to physically intervene. However, in many situations, there are ways to minimize the need for any physical intervention—and to reduce the risk of injury to you and the person.
The best way to avoid going hands-on is to avoid the need to restrain in the first place. To do that:
- Be aware of changes in the person’s behavior that can be warning signs of potential escalation
- Focus on proxemics and verbal de-escalation
- Learn how to set limits effectively
- Get training in how to assess risk
- Avoid being drawn into power struggles
- Choose the least-restrictive option possible in every situation
How can you do all this in a chaotic, fast-paced environment? Here are some posts, guides, and resources that can help:
9. Debrief
Be sure to debrief after any crisis. This will help you find patterns and triggers, build teamwork with your colleagues, and prevent the situation from happening again. When you debrief, you can also pinpoint specific ways to proactively address the causes of difficult behavior. Debriefing also helps the person foster resilience and develop effective coping skills.
10. Join hands
A person-centered, strength-based approach is about treating people with respect and dignity and working together to improve the person’s quality of life. And, by extension, the quality of your life, your colleagues’ lives, and the lives of the person’s family members.
Throughout your organization, collaborate as a team to adopt a consistent approach. Work to gain buy-in of person-focused care, not only from all staff departments and all organizational leaders, but from clients and their families as well. This allows everyone to take an active role in promoting their own well-being, thereby enhancing the well-being of others.
11. Start immediately
In many environments, you can get your person-centered approach off the ground before the person even comes into your care—during the discovery process, prior to admission, during intake, etc. Being person-centered at every step of a person’s journey furthers their inclusion and engagement in their education, care, treatment, recovery, family, community, peer groups, and growth.
12. Lead the way
Model these strategies for your colleagues. Help staff shift from a deficit-based mindset to a strength-based mindset. Show them the results you achieve when you focus on a person’s abilities. Teach them how instead of looking at a person as “damaged,” they should see the person as a survivor.
Person-centered training
As person-centered care becomes a matter of policy—not just a best practice, it’s crucial and often required to implement approaches that meet every person's individual needs.
Combining your individualized care initiatives with the right training will not only help you comply with laws and regulations. It will also give you even more tools for helping those in care be more than just receivers of care. You’ll be better equipped to help them be their own care partners to the best of their ability — positioning both them and staff in roles of empowerment and respect.
With CPI, you can get trained in—and even be a trainer of—person-focused programs including Nonviolent Crisis Intervention® and Dementia Capable Care training.
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